Quality care delivery is shaped by many variables, including those healthcare facility latent environmental conditions that can potentially contribute to adverse healthcare events. Often, built environment features that negatively impact patients and staff are incorporated unthinkingly into healthcare facilities during the facility design proces when there is a lack of focus on goals related to patient safety. Few healthcare organizations are leveraging the opportunity to use the facility design process to transform the safety culture i their organizations. The key goals of this project are to develop a Patient Safety Risk Assessment (PSRA) toolkit that includes an evidence-based design strategy framework (Safe Design Roadmap), a proactive Patient Safety Risk Assessment tool, instructions and methods for its use, user guides and white papers, and an educational platform with case studies to accelerate the adoption, integration and institutionalization of the physical environmental design, as a means to help eradicate patient harm. The project will support AHRQ's mission to improve healthcare safety for all Americans by developing 1) a new research and practice methodology as well as 2) supporting dissemination and implementation of this new methodology that will help in the development of safer healthcare facilities in the future. This project aims to develop and disseminate over the course of three years an online proactive patient safety risk assessment (PSRA) toolkit. Three multidisciplinary seminars will be conducted between 2013 and 2015 in collaboration with the Facilities Guidelines Institute and key partners. The project will focus on the following over the three years: 1. Year 1: Safe Design Roadmap and PSRA tool development - In the first year, the structure and format for the PSRA will be developed. The safe design roadmap will be further developed based on interviews with three healthcare CEOs. Finally, a seminar will be conducted in collaboration with the MedStar Institute for Innovation to discuss unresolved issues. 2. Year 2: PSRA tool validation and integration - In the second year, the PSRA tool will be validated and integrated into a toolkit through focus group feedback and pilot testing at healthcare organizations. A second seminar will be hosted at Kaiser Permanente's Garfield Innovation Center enabling the tool to be further tested. 3. Year 3: PSRA toolkit dissemination and evaluation - In the third year, the PSRA toolkit will be disseminated via an online platform. The final seminar will be held in conjunction with the national ASHE PDC summit in 2015 to share the key findings of the project and to educate healthcare design stakeholders on the implementation of the PSRA. PUBLIC HEALTH RELEVANCE: Medication errors, patient falls and healthcare acquired infections are a serious problem in U.S. hospitals as well as worldwide. Research shows that healthcare physical environment factors including noise, poor lighting, inadequate ventilation and building layout and design contribute to these negative outcomes in healthcare. The goal of this project is to create safer healthcare environments by developing a proactive patient safety risk assessment toolkit to enable careful consideration of built environment factors during the design and construction of healthcare facilities.